Health professionals and the contingent body: social determinants in the curriculum.

Health professionals and the contingent body: social determinants in the curriculum Background Health professional education situates health workers within an objectivist biomedical model. Yet workers are also expected to provide patient centred care to a significant proportion of people who have worse health outcomes associated with the social determinants of health. This study asks how health professionals are educated and what are some of the consequences? Summary of work The qualitative study interviewed 17 health professionals in order to explore how they were educated and some of the consequences of that through a lens of critical pedagogy, reflexivity, poststructural feminist critiques of education and Foucault’s theories of power/knowledge. Ethics approval was gained through Murdoch University. Results Participants expressed a slippage of the objectivist self with both themselves and patients. Their language of choice, control, individuality and the struggle to link abstract theorizing of biomedicine especially in relation to the social determinants of health and their own lived experience was apparent. Strategies to implement and understand social determinants of health only seemed to reinforce the ontological divide and the need for translation. Discussions and Conclusion The split between subjectivity and objectivity amplifies the ‘Othering’ that occurs in the biomedical curriculum and practice. This leaves health professionals unprepared to work with poverty and deprivation, and apparently less able to self-regulate effectively. In spite of evidence to the contrary, and experiencing suffering themselves, health professionals were unable to re-imagine how this could be different. Take home message Health professionals’ selves and bodies are tied up with their patients in a messy temporal space that seems to co-produce the contingent body. Narratives of trauma seem to be a way of managing the ontological gap between health as a definitive state and healing as a durative process located in time and space

DNA methylation and body mass index from birth to adolescence : meta-analyses of epigenome-wide association studies

Background DNA methylation has been shown to be associated with adiposity in adulthood. However, whether similar DNA methylation patterns are associated with childhood and adolescent body mass index (BMI) is largely unknown. More insight into this relationship at younger ages may have implications for future prevention of obesity and its related traits. Methods We examined whether DNA methylation in cord blood and whole blood in childhood and adolescence was associated with BMI in the age range from 2 to 18 years using both cross-sectional and longitudinal models. We performed meta-analyses of epigenome-wide association studies including up to 4133 children from 23 studies. We examined the overlap of findings reported in previous studies in children and adults with those in our analyses and calculated enrichment. Results DNA methylation at three CpGs (cg05937453, cg25212453, and cg10040131), each in a different age range, was associated with BMI at Bonferroni significance, P <1.06 x 10(-7), with a 0.96 standard deviation score (SDS) (standard error (SE) 0.17), 0.32 SDS (SE 0.06), and 0.32 BMI SDS (SE 0.06) higher BMI per 10% increase in methylation, respectively. DNA methylation at nine additional CpGs in the cross-sectional childhood model was associated with BMI at false discovery rate significance. The strength of the associations of DNA methylation at the 187 CpGs previously identified to be associated with adult BMI, increased with advancing age across childhood and adolescence in our analyses. In addition, correlation coefficients between effect estimates for those CpGs in adults and in children and adolescents also increased. Among the top findings for each age range, we observed increasing enrichment for the CpGs that were previously identified in adults (birth P-enrichment = 1; childhood P-enrichment = 2.00 x 10(-4); adolescence P-enrichment = 2.10 x 10(-7)). Conclusions There were only minimal associations of DNA methylation with childhood and adolescent BMI. With the advancing age of the participants across childhood and adolescence, we observed increasing overlap with altered DNA methylation loci reported in association with adult BMI. These findings may be compatible with the hypothesis that DNA methylation differences are mostly a consequence rather than a cause of obesity.Peer reviewe